To evaluate if surgical removal of residual disease adds benefit in stage IV melanoma patients with partial response or stable disease after a minimum 9 months of first-line PD-1 inhibition. Primary endpoint: Disease-free survival (DFS) at 12 months.
A Phase II Randomized Controlled Open-Label Parallel Group Interventional Multicenter Trial. Patients with metastatic melanoma, stratified for stage M1a or M1b/M1c, that have received first-line treatment with PD-1 inhibitors for a minimum of 9 months resulting in either partial response or stable disease according to RECIST 1.1 will be eligible. Patients will be screened for operability based on CT-scans examined by a multidisciplinary team, with the criteria that complete (R0) resection of all metastases should be possible. If the multidisciplinary team find that this would be possible, patients will be included and randomized 1:1 to either surgery with continued PD1-inhibition or current standard of care with continued PD1-inhibition only. At progression, treatment will be according to the treating medical oncologist. Active follow-up will be performed for 12 months.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Surgical removal of metastases aimed at R0 resection.
Continued PD1-inhibitor treatment according to current treatment standards.
Sahlgrenska University Hospital
Gothenburg, Sweden
DFS 12 months
Disease free survival
Time frame: 12 months
SAE 12 months
Serious adverse events
Time frame: 12 months
Complications
Surgical complications according to the Clavien-Dindo classification
Time frame: 3 months post operatively
R0 resection
Rate of R0 resections according to pathology report
Time frame: 3 months post operatively
PFS 12 months
Progression free survival
Time frame: 12 months
MSS 12 months
Melanoma specific survival
Time frame: 12 months
OS 12 months
Overall survival
Time frame: 12 months
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